头针治疗缺血性脑卒中后吞咽障碍的机制研究概况  

Overview of research on the mechanism of swallowing disorders after ischemic stroke treated with head acupuncture

作　　者：杨晨 王东岩[2] 董旭[2] 周以皓 张虹岩 杨思宇 李东霞 YANG Chen;WANG Dongyan;DONG Xu;ZHOU Yihao;ZHANG Hongyan;YANG Siyu;LI Dongxia(Graduate School,Heilongjiang University of Traditional Chinese Medicine,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学研究生院,哈尔滨150040 [2]黑龙江中医药大学附属第二医院针灸三科

出　　处：《环球中医药》2025年第3期609-614,共6页Global Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(82374601);黑龙江省自然科学基金联合引导项目(LH2019H113)。

摘　　要：吞咽障碍是缺血性脑卒中后常见并发症之一,头针疗法在治疗缺血性脑卒中及其并发症方面疗效确切。本文对近年来国内外头针治疗缺血性脑卒中后吞咽障碍的机制研究进行总结,归纳发现头针作用机制如下:(1)上调血管内皮生长因子、缺氧诱导因子-1α表达水平,激活Wnt/β-连环蛋白信号通路促进血管再生,加快脑血流速度,改善循环灌注和代谢,从而改善病灶缺血状态;(2)提高吞咽皮质兴奋性刺激麻痹的吞咽肌,平衡左右侧脑区活性增强脑网络连接,从而增强吞咽中枢功能调控;(3)上调神经生长因子、脑源性神经营养因子水平,下调肿瘤坏死因子-α、白细胞介素-6、白细胞介素-1β等促炎因子水平,改善免疫稳定性;(4)减轻兴奋性谷氨酸毒性,保护神经元;(5)提高神经突触可塑性,重塑吞咽反射通路;(6)抑制细胞凋亡,减轻神经破坏程度。头针治疗可以多途径修复神经系统损伤,促进吞咽功能恢复。今后的研究应对头针作用靶点与疗效进行进一步探索,为临床头针治疗缺血性脑卒中后吞咽障碍提供理论依据。Dysphagia is one of the common complications after ischemic stroke,and head acupuncture therapy has remarkable efficacy in the treatment of ischemic stroke and its complications.In this paper,we summarized the mechanism studies on the treatment of swallowing disorder after ischemic stroke with head acupuncture at home and abroad in recent years,and summarized the mechanisms of head acupuncture's action as follows:(1)Up-regulate the expression level of vascular endothelial growth factor and hypoxia-inducible factor-1α,activate the Wnt/β-catenin signaling pathway to promote vascular regeneration,accelerate cerebral blood flow,improve perfusion and metabolism,thus improving the ischemic state of the lesion;(2)Increase the excitability of swallowing cortex to stimulate the paralyzed swallowing muscle,balance the activity of left and right side brain regions to enhance brain network connection,thus enhancing the central function regulation of swallowing;(3)Up-regulate the level of nerve growth factor,brain-derived neurotrophic factor,down-regulate tumor necrosis factor-α,interleukin-6,interleukin-1βand other pro-inflammatory factors to improve immune stability;(4)Reduce excitatory glutamate toxicity to protect neurons;(5)Improve synaptic plasticity to remodel the swallowing reflex pathway;(6)Inhibit apoptosis to reduce the degree of nerve damage.Multi-pathway repair of neurological damage promotes the recovery of swallowing function.Future studies should further explore the target point of head acupuncture action and efficacy to provide references for clinical head acupuncture treatment of swallowing disorder after ischemic stroke.

关 键 词：头针 缺血性脑卒中 吞咽障碍 机制 细胞因子 脑网络 神经重塑 细胞凋亡 

分 类 号：R245.32[医药卫生—针灸推拿学]